Open to opportunities

Pinkies World

@pinkiesworld

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Experienced claims adjudicator and software tester in healthcare.

India

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What I'm looking for

I seek a dynamic role in a forward-thinking organization that values innovation and offers opportunities for professional growth.

I am a dedicated professional with over 5.8 years of experience in the healthcare domain, specializing in claims adjudication and software testing. My journey began at Cognizant Technology Solutions, where I honed my skills as a Programmer Analyst, contributing significantly to projects like Healthnet and CareFirst. My commitment to excellence has been recognized through multiple awards, including the Star Award for outstanding performance.

Throughout my career, I have demonstrated a strong ability to adapt to new technologies and processes. I have successfully led training sessions and audits, ensuring that my teams meet and exceed client expectations. My technical expertise encompasses various applications and testing methodologies, making me a versatile asset in any project.

Experience

Work history, roles, and key accomplishments

Programmer Analyst

Cognizant Technology Solution

Conducted functional testing on the FACETS application to optimize medical claims processing, ensuring secure transactions under SDLC. Created and designed test cases, performed database validation, and tracked bugs in HP ALM.

Functional Testing Facets SDLC FTP EDI Testing Design Data Validation

Programmer Analyst

Cognizant Technology Solution

Processed US Health Care Claims (UB and HCFA) for payment, coordinating benefits and identifying fraud billings. Managed reper-claims by identifying errors and adjusting them, ensuring proper quality control to meet client SLAs.

Healthcare Citrix ICA Client UB HCFA Claims SLA Management Training ABS Q Care Macess Applications

Senior Associate

NTT Data Process

Investigated and resolved insurance claim denials and disputes, providing operational support by reviewing and analyzing findings related to Appeals and Grievances. Utilized guidelines and review tools to conduct extensive research and analyze issues, processing claims in ONBASE application.

Appeals Healthcare Onbase Grievances Research Data Analysis

Senior Associate

NTT Data Process

Processed US Health Care Claims (UB and HCFA) by adjudicating them in the Customer Server via Citrix ICA Client. Validated member eligibility and ensured proper quality control to meet and exceed client SLAs.

Claim Adjudication Healthcare Citrix ICA Client UB HCFA Claims SLA Management Quality Control

Education

Degrees, certifications, and relevant coursework

Kongunadu Arts and Science College

Bachelor of Science, Computer Technology

Grade: 82%

Graduated with a Bachelor of Science in Computer Technology. The curriculum provided a foundational understanding of computer systems and related technologies.